Gastro-oesophageal Reflux Disease Flashcards
What is GORD?
A condition where acid from the stomach flows through the lower oesophageal sphincter and into the oesophagus.
What type of epithelial lining does the oesophagus have?
Squamous epithelial lining.
What type of epithelial lining does the stomach have?
Columnar epithelial lining.
List some common triggers of GORD.
- Greasy or spicy foods
- Coffee and tea
- Alcohol
- NSAIDs
- Stress
- Smoking
- Obesity
- Hiatus hernia
What is dyspepsia?
A non-specific term used to describe indigestion.
What are some symptoms of GORD?
- Heartburn
- Acid regurgitation
- Retrosternal or epigastric pain
- Bloating
- Nocturnal cough
- Hoarse voice
What are some red flags associated with dyspepsia?
- Dysphagia
- Aged >55 years
- Weight loss
- Treatment-resistant dyspepsia
- Nausea and vomiting
- Upper abdominal mass on palpation
- Anaemia
- Raised platelets
What is a hiatus hernia?
Herniation of the stomach up through the diaphragm.
What are the four types of hiatus hernia?
- Sliding hernia
- Rolling hernia
- Combo sliding and rolling
- Large opening with additional abdominal organs entering thorax
What is the purpose of endoscopy in GORD?
To assess conditions such as gastritis, peptic ulcers, upper GI bleeding, oesophageal varices, Barrett’s oesophagus, oesophageal stricture, and malignancy.
What is the urgent indication for endoscopy?
Patients with evidence of an upper GI bleed (melena or coffee ground vomit).
List some lifestyle changes recommended for managing GORD.
- Reduce caffeine
- Weight loss
- Smoking cessation
- Smaller meals
- Avoid meals before bedtime
- Stay upright following meals
- Don’t lie flat
What medications are commonly used to manage GORD?
- Antacids (e.g. Gaviscon, Pepto-bismol)
- Proton pump inhibitors (PPIs) (e.g. omeprazole)
- Histamine H2-receptor antagonists (e.g. famotidine)
- Surgery (e.g. laparoscopic fundoplication)
What is Helicobacter pylori?
A gram-negative aerobic bacteria that lives in the stomach and damages the epithelial lining.
What is the recommended testing protocol for H. pylori?
Must have 2 weeks PPI free pre-testing.
What are the methods for investigating H. pylori?
- Stool antigen test
- Urea breath test
- H. pylori antibody blood test
- Rapid urease test (CLO test)
What is the eradication regime for H. pylori?
- PPI (e.g. omeprazole)
- Amoxicillin (7 days)
- Clarithromycin (7 days)
What is Barrett’s oesophagus?
A metaplasia where the lower oesophageal epithelium changes from squamous to columnar epithelium.
What is the stepwise progression of Barrett’s oesophagus?
- No dysplasia
- Low-grade dysplasia
- High-grade dysplasia
- Adenocarcinoma
What treatments are available for Barrett’s oesophagus?
- Endoscopic monitoring
- PPIs
- Endoscopic ablation (radiofrequency ablation)
What is Zollinger-Ellison Syndrome?
A rare condition where a duodenal or pancreatic tumour secretes excess gastrin.
What does gastrin do?
Stimulates acid secretion in the stomach.
What are the symptoms of excess gastrin?
- Severe dyspepsia
- Diarrhoea
- Peptic ulcers
